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What Is an Independent Medical Examination and Do I Have to Attend?

Daniel Klosowski
doctors

First, an injured worker in Illinois should be aware that under the Illinois Workers’ Compensation Act, the injured worker has the right to treat with their own physician. Just because a person was injured at work, does not mean that the person has to treat with the company doctor. (The specifics and potential limitations of treating doctors will be the topic of a later blog post.)  However, there is one instance where an injured worker will need to visit a doctor that was chosen by the workers’ compensation insurance carrier for their employer and that is the Independent Medical Examination (IME) or Section 12 Examination.

An IME is a one-time evaluation where a doctor of the insurance company’s choosing examines the injured worker.  The doctor will perform a physical examination and will also review the diagnostic tests that the injured worker has undergone prior to the IME.  Often the injured worker will be told to bring copies of the films for any of their previous diagnostic tests.  In some instances, the IME doctor will review the medical records for the injured worker’s prior medical treatment.  There is not a physician-patient relationship established between the doctor and the injured worker.  The IME examiner does not become the injured worker’s treating doctor.  Also, there is no doctor-patient confidentiality between the IME examiner and the injured worker.  In fact, the IME doctor will draft a report with their findings, opinions, and recommendations for further treatment, if any, and the injured worker’s ability to return to work.

As an injured worker who has been scheduled to attend a Section 12 Examination or IME, the person should be aware that there are certain requirements that must be met by the insurance company prior to attending the IME and the day of the IME.  First, the insurance company must provide reasonable notice of the IME.  This is a somewhat subjective standard, but the injured worker must be given enough time to know that they have to attend the IME and be able to adjust their schedule to do so.  Second, the insurance company is required to send a mileage check to the injured worker for their travel costs.  This mileage check is not the exact amount of what the injured worker spends to attend the IME.  The injured worker could receive more or less than their actual costs based on the formula that is used to determine mileage.  If either of the above have not happened when attending an IME, contact an attorney who handles workers’ compensation claims.

After the IME report is completed, the workers’ compensation insurance company is likely to follow the advice of the IME physician.   If the IME physician feels that the injured worker is in need of further treatment, then the insurance company will likely, but not always, approve the recommended care.  However, if the IME physician states that the injured worker does not need any further care, then the insurance company may refuse to authorize any further treatment.  If an injured worker finds themselves in a situation where an IME report has resulted in further treatment being denied, contacting a workers’ compensation attorney as soon as possible is important.  The attorney can argue through the trial process if necessary, as to why the injured worker should receive the recommended treatment that is being denied.

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